Conexiant
Login
  • The Analytical Scientist
  • The Cannabis Scientist
  • The Medicine Maker
  • The Ophthalmologist
  • The Pathologist
  • The Traditional Scientist
The Pathologist
  • Explore Pathology

    Explore

    • Latest
    • Insights
    • Case Studies
    • Opinion & Personal Narratives
    • Research & Innovations
    • Product Profiles

    Featured Topics

    • Molecular Pathology
    • Infectious Disease
    • Digital Pathology

    Issues

    • Latest Issue
    • Archive
  • Subspecialties
    • Oncology
    • Histology
    • Cytology
    • Hematology
    • Endocrinology
    • Neurology
    • Microbiology & Immunology
    • Forensics
    • Pathologists' Assistants
  • Training & Education

    Career Development

    • Professional Development
    • Career Pathways
    • Workforce Trends

    Educational Resources

    • Guidelines & Recommendations
    • App Notes

    Events

    • Webinars
    • Live Events
  • Events
    • Live Events
    • Webinars
  • Profiles & Community

    People & Profiles

    • Power List
    • Voices in the Community
    • Authors & Contributors
  • Multimedia
    • Video
    • Podcasts
Subscribe
Subscribe

False

The Pathologist / Issues / 2023 / Oct / The Promise of Personalized Medicine for the Pancreas
Oncology Genetics and epigenetics Oncology Insights

The Promise of Personalized Medicine for the Pancreas

The role of molecular pathology in pancreatic ductal adenocarcinoma is crucial for patient outcomes

By Natasha Singh 10/16/2023 Discussion 2 min read

Share

Pancreatic ductal adenocarcinoma (PDAC) is one of the most prevalent neoplastic disorders with poor prognosis. The etiology of the disease is multifactorial: with environmental, pre existing medical, and hereditary factors all playing a role. The precursor lesions are pancreatic intraepithelial neoplasia, intraductal papillary mucinous neoplasm, mucinous cystic neoplasm, and familial pancreatic cancer, among others. The incidence is 10–12 cases per 100,000, and it is the fourth leading cause of death from cancer in the US. It usually occurs between 60–80 years of age, with a slight male predominance – and is more commonly seen in Black populations in the US. Typical symptoms include painless jaundice and weight loss.

There is an increased importance of molecular diagnostics in every organ system, and the pancreas is not far behind. As we know, PDAC is a biologically aggressive malignancy with poor prognosis. The tumors can present clinically benign as back pain, jaundice, and weight loss. Even with advanced surgical and chemotherapeutic options, the survival rate is less than 10 percent. Typically, diagnosis is made on endoscopic ultrasound-guided fine needle aspiration. However, whole-genome sequencing has unfolded the genomic landscape of PDAC, allowing for a whole new approach to its diagnosis.

Pancreas: Adenocarcinoma vs. Normal Ductal Epithelium on FNA, Ed Uthman / Flickr.com / CC BY

The key driving mutations are KRAS, TP53, SMAD4, and CDKN2A. Other genes, including ARID1A, KDM6A, MLL3, TGFBR2, RBM10, and BCORL1, are found in less than 10 percent of tumors. Gene alterations associated with targeted therapy, such as ERBB2 amplification, BRAF gene fusions and mutations, and DNA damage repair genes mutations like BRCA1, BRCA2, or PALB2, are also found in a small percentage of PDAC patients. Advances in molecular pathology in PDAC help in the advent of targeted therapy, which is more effective. 

Without doubt, KRAS is the major driving mutation and target for therapies. Thus, KRAS-related molecules and pathways are research hotspots. Many CAR-T targets have been identified, including MSLN, CEA, CD133, Tn/STn, B7-H3, KRAS G12D, PD-1 and HER2. Meanwhile, antibody drug conjugates and the bispecific T-cell engager platform are able to target PDAC cells with precision. Immune checkpoint blockades such as PDL1 also have a role that is related to the number of genetic mutations; namely, the lower the mutations the more it will be resistant to PDL1 inhibitors. All these targeted therapies would aid in providing diverse therapeutic options for pancreatic ductal adenocarcinoma and improve its poor prognosis. 

With appropriate techniques and methodologies, molecular pathology can help realize personalized treatment options for PDAC – with the hope of increasing long term survival for patients who currently have a dismal prognosis.

Newsletters

Receive the latest pathology news, personalities, education, and career development – weekly to your inbox.

Newsletter Signup Image

About the Author(s)

Natasha Singh

Cytopathology Fellow at Columbia University, New York, USA.

More Articles by Natasha Singh

Explore More in Pathology

Dive deeper into the world of pathology. Explore the latest articles, case studies, expert insights, and groundbreaking research.

False

Advertisement

Recommended

False

Related Content

Breathing New Life into Diagnostics
Genetics and epigenetics
Breathing New Life into Diagnostics

January 22, 2024

6 min read

Jonathan Edgeworth on how metagenomics could transform testing for respiratory infections

Molecular Spectacular
Genetics and epigenetics
Molecular Spectacular

January 8, 2024

1 min read

A look at last year’s most interesting molecular pathology stories

Redefining Diagnostic Reference Standards
Genetics and epigenetics
Redefining Diagnostic Reference Standards

January 3, 2022

1 min read

Find out what Horizon Discovery’s diagnostic reference standards can do for your workflow

Defining the Next Generation of NGS
Genetics and epigenetics
Defining the Next Generation of NGS

December 31, 2021

1 min read

Overcoming challenges of the typical NGS workflow with the Ion Torrent™ Genexus™ System

False

The Pathologist
Subscribe

About

  • About Us
  • Work at Conexiant Europe
  • Terms and Conditions
  • Privacy Policy
  • Advertise With Us
  • Contact Us

Copyright © 2025 Texere Publishing Limited (trading as Conexiant), with registered number 08113419 whose registered office is at Booths No. 1, Booths Park, Chelford Road, Knutsford, England, WA16 8GS.